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12 April 2006
Behavioral therapy appears to be effective for the treatment of drug addiction in patients with severe and persistent mental illness, study findings show.
Lead researcher Alan Bellack says that the treatment is primarily suitable for people with current or recent drug dependence and psychiatric disorders such as schizophrenia, bipolar disorder, and persistent depression or anxiety disorders.
The Behavioral Treatment for Substance Abuse in Severe and Persistent Mental Illness (BTSAS) is a social learning intervention that includes motivational interviewing, a urinalysis contingency, and social skills training.
To test the efficacy of the treatment, Bellack and colleagues compared it with Supportive Treatment for Addiction Recovery (STAR) – a supportive group discussion treatment – in 129 stabilized outpatients meeting DSM criteria for drug dependence (cocaine, heroin, or cannabis) and serious mental illness.
Among the participants, 39.5% had schizophrenia or schizoaffective disorder, 55.8% had major affective disorders, and the remainder met criteria for severe and persistent mental illness and other axis I disorders.
The patients were randomly assigned to receive one of the two treatments, both of which were administered by trained healthcare professionals in small groups, twice a week for 6 months.
In all, 110 participants became engaged in treatment, with the risk of dropout for BTSAS about half that for STAR. Patients assigned to BTSAS also attended significantly more sessions than those receiving STAR.
Urinalysis showed that BTSAS participants were more likely to have clean urine test results than those receiving STAR. Indeed, 54.1% of BTSAS patients had at least one 4-week block of continuous abstinence, compared with 16.3% of STAR patients. Respective percentages for multiple 4-week blocks and at least one 8-week block were 44.3% versus 10.2% and 32.8% versus 8.16%.
The researchers note that patients participating in BTSAS, compared with those receiving STAR, had fewer inpatient admissions, more money available for living expenses, and reported a significant increase in quality of life.
"These data provide considerable support for the efficacy of BTSAS," they say.
Reporting in the Archives of General Psychiatry, the researchers add that they are currently conducting a trial of a modified version of BTSAS that they hope will increase engagement and thereby widen the applicability of the therapy.
Source: Arch Gen Psychiatry 2006; 63: 426–432
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